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Article ; Online: Vaginal carriage of Haemophilus influenzae in a non-pregnant reproductive-age population.

Limaye, Meghana A / Brubaker, Sara / Randis, Tara M / Ratner, Adam J

2023 Volume 23, Issue 1, Page(s) 141

Abstract: Background: Haemophilus influenzae (Hi) is an emerging cause of early onset neonatal sepsis, but mechanisms of transmission are not well understood. We aimed to determine the prevalence of vaginal carriage of Hi in reproductive age women and to examine ... ...

Abstract	Background: Haemophilus influenzae (Hi) is an emerging cause of early onset neonatal sepsis, but mechanisms of transmission are not well understood. We aimed to determine the prevalence of vaginal carriage of Hi in reproductive age women and to examine behavioral and demographic characteristics associated with its carriage. Methods: We performed a secondary analysis of stored vaginal lavage specimens from a prospective cohort study of nonpregnant reproductive-age women. After extraction of bacterial genomic DNA, samples were tested for the presence of the gene encoding Haemophilus protein d (hpd) by quantitative real-time polymerase chain reaction (PCR) using validated primers and probe. PCR for the V3-V4 region of the 16 S rRNA gene (positive control) assessed sample quality. Samples with cycle threshold (C Results: 415 samples were available. 315 (75.9%) had sufficient bacterial DNA and were included. 14 (4.4%) were positive for hpd. There were no demographic or behavioral differences between the women with Hi vaginal carriage and those without. There was no difference in history of bacterial vaginosis, vaginal microbiome community state type, or presence of Group B Streptococcus in women with and without vaginal carriage of Hi. Conclusion: Hi was present in vaginal lavage specimens of 4.4% of this cohort. Hi presence was unrelated to clinical or demographic characteristics, though the relatively small number of positive samples may have limited power to detect such differences.
MeSH term(s)	Haemophilus influenzae/genetics ; Haemophilus Infections/epidemiology ; Haemophilus Infections/microbiology ; Haemophilus Infections/prevention & control ; Haemophilus Infections/transmission ; Humans ; Female ; Cohort Studies ; Prevalence ; Adult ; Adolescent ; Young Adult ; Middle Aged ; Polymerase Chain Reaction ; Microbiota ; Vagina/microbiology ; Neonatal Sepsis/microbiology ; Neonatal Sepsis/prevention & control ; Male ; DNA, Bacterial/genetics
Chemical Substances	DNA, Bacterial
Language	English
Publishing date	2023-05-19
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041505-9
ISSN	1471-2180 ; 1471-2180
ISSN (online)	1471-2180
ISSN	1471-2180
DOI	10.1186/s12866-023-02885-y
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Article ; Online: Authors' reply re: 'Vaginal seeding' after a caesarean section provides benefits to newborn children: AGAINST: Vaginal microbiome transfer - a medical procedure with clear risks and uncertain benefits.

Limaye, Meghana A / Ratner, Adam J

BJOG : an international journal of obstetrics and gynaecology

2020 Volume 127, Issue 7, Page(s) 906–907

MeSH term(s)	Cesarean Section ; Female ; Humans ; Infant, Newborn ; Microbiota ; Pregnancy ; Vagina
Language	English
Publishing date	2020-03-09
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2000931-8
ISSN	1471-0528 ; 0306-5456 ; 1470-0328
ISSN (online)	1471-0528
ISSN	0306-5456 ; 1470-0328
DOI	10.1111/1471-0528.16174
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Article ; Online: Thromboelastography versus Standard Coagulation Assays in Patients with Postpartum Hemorrhage.

Perelman, Allison D / Limaye, Meghana / Blakemore, Jennifer / Hoskins, Iffath A

American journal of perinatology

2022

Abstract: Objective: Thromboelastography (TEG), a point-of-care test that measures blood's dynamic viscoelastic properties, is routinely used to guide resuscitation in surgical specialties with high hemorrhage risk. Patients with ongoing postpartum hemorrhage ( ... ...

Abstract	Objective: Thromboelastography (TEG), a point-of-care test that measures blood's dynamic viscoelastic properties, is routinely used to guide resuscitation in surgical specialties with high hemorrhage risk. Patients with ongoing postpartum hemorrhage (PPH) often develop coagulopathy and hypofibrinogenemia. Timely assessment of fibrinogen is crucial because cryoprecipitate for repletion requires thawing time prior to administration. TEG may provide rapid assessment of coagulopathy in ongoing hemorrhage but this has not been thoroughly studied. Our objective was to determine if TEG accurately reflects coagulopathy in ongoing PPH when compared with standard assays. Study design: This was a retrospective cohort study of people with ongoing PPH (quantified blood loss >1,000 mL), from January 1, 2016, to December 31, 2019. TEG variables and standard coagulation parameters were compared in patients who had both assays drawn simultaneously. As a secondary analysis, patients who had TEG were compared with those who did not. The Mann-Whitney, Fisher's exact, Kruskal-Wallis, Spearman's rho, and logistic regression tests were used for analysis. Significance was set at Results: A total of 680 patients were included, 69 of whom had TEG and coagulation parameters drawn simultaneously and were included in the primary analysis. The remainder were included in the secondary analysis. TEG variables and coagulation assays correlated significantly-prolonged R with increased PTT (rho 0.25, Conclusion: TEG correlated significantly with standard laboratory assays in ongoing PPH, including for patients with hypofibrinogenemia. Given the point-of-care nature and rapid turnaround time, TEG should be considered for timely hemorrhage evaluation and directed resuscitation of coagulopathy. Key points: · TEG significantly correlates with standard laboratory measures of coagulopathy in postpartum hemorrhage, including in patients with hybofibrinogemia (fibrinogen <200).. · TEG is routinely used in nonobstetric hemorrhage, and should be considered in PPH.. · Due to the point-of-care nature, TEG may allow for rapid guided resuscitation, including fibrinogen..
Language	English
Publishing date	2022-12-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/a-1974-5055
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Article ; Online: 'Vaginal seeding' after a caesarean section provides benefits to newborn children: AGAINST: Vaginal microbiome transfer - a medical procedure with clear risks and uncertain benefits.

Limaye, Meghana A / Ratner, Adam J

BJOG : an international journal of obstetrics and gynaecology

2019 Volume 127, Issue 2, Page(s) 302

MeSH term(s)	Cesarean Section ; Child ; Female ; Humans ; Infant, Newborn ; Microbiota ; Pregnancy ; Vagina
Language	English
Publishing date	2019-11-06
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	2000931-8
ISSN	1471-0528 ; 0306-5456 ; 1470-0328
ISSN (online)	1471-0528
ISSN	0306-5456 ; 1470-0328
DOI	10.1111/1471-0528.15977
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Article: Thromboelastography versus Standard Coagulation Assays in Patients with Postpartum Hemorrhage

Perelman, Allison D. / Limaye, Meghana / Blakemore, Jennifer / Hoskins, Iffath A.

American Journal of Perinatology

2022

Abstract	Objective: Thromboelastography (TEG), a point-of-care test that measures blood's dynamic viscoelastic properties, is routinely used to guide resuscitation in surgical specialties with high hemorrhage risk. Patients with ongoing postpartum hemorrhage (PPH) often develop coagulopathy and hypofibrinogenemia. Timely assessment of fibrinogen is crucial because cryoprecipitate for repletion requires thawing time prior to administration. TEG may provide rapid assessment of coagulopathy in ongoing hemorrhage but this has not been thoroughly studied. Our objective was to determine if TEG accurately reflects coagulopathy in ongoing PPH when compared with standard assays. Study Design: This was a retrospective cohort study of people with ongoing PPH (quantified blood loss >1,000 mL), from January 1, 2016, to December 31, 2019. TEG variables and standard coagulation parameters were compared in patients who had both assays drawn simultaneously. As a secondary analysis, patients who had TEG were compared with those who did not. The Mann–Whitney, Fisher's exact, Kruskal–Wallis, Spearman's rho, and logistic regression tests were used for analysis. Significance was set at p < 0.05. Results: A total of 680 patients were included, 69 of whom had TEG and coagulation parameters drawn simultaneously and were included in the primary analysis. The remainder were included in the secondary analysis. TEG variables and coagulation assays correlated significantly—prolonged R with increased PTT (rho 0.25, p = 0.04), prolonged K and decreased α angle with decreased fibrinogen (rho −0.61, p < 0.001; rho 0.24, p < 0.001), and decreased maximum amplitude with decreased platelets (rho 0.62, p < 0.001). Those who had thromboelastographic assays had higher blood loss and need for interventions to manage hemorrhage than those who did not. Conclusion: TEG correlated significantly with standard laboratory assays in ongoing PPH, including for patients with hypofibrinogenemia. Given the point-of-care nature and rapid turnaround time, TEG should be considered for timely hemorrhage evaluation and directed resuscitation of coagulopathy. Key Points: TEG significantly correlates with standard laboratory measures of coagulopathy in postpartum hemorrhage, including in patients with hybofibrinogemia (fibrinogen <200). TEG is routinely used in nonobstetric hemorrhage, and should be considered in PPH. Due to the point-of-care nature, TEG may allow for rapid guided resuscitation, including fibrinogen.
Keywords	postpartum hemorrhage ; thromboelastography ; coagulopathy ; fibrinogen ; massive transfusion
Language	English
Publishing date	2022-11-08
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/a-1974-5055
Database	Thieme publisher's database

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Article ; Online: A review of fetal and neonatal consequences of maternal systemic lupus erythematosus.

Limaye, Meghana A / Buyon, Jill P / Cuneo, Bettina F / Mehta-Lee, Shilpi S

Prenatal diagnosis

2020 Volume 40, Issue 9, Page(s) 1066–1076

Abstract: Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and is commonly seen in pregnancy. The physiologic and immunologic changes of pregnancy may alter the course of SLE and impact maternal, fetal, and neonatal health. ... ...

Abstract	Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and is commonly seen in pregnancy. The physiologic and immunologic changes of pregnancy may alter the course of SLE and impact maternal, fetal, and neonatal health. Multidisciplinary counseling before and during pregnancy from rheumatology, maternal fetal medicine, obstetrics, and pediatric cardiology is critical. Transplacental passage of autoantibodies, present in about 40% of women with SLE, can result in neonatal lupus (NL). NL can consist of usually permanent cardiac manifestations, including conduction system and myocardial disease, as well as transient cutaneous, hematologic, and hepatic manifestations. Additionally, women with SLE are more likely to develop adverse pregnancy outcomes such as preeclampsia, fetal growth restriction, and preterm birth, perhaps due to an underlying effect on placentation. This review describes the impact of SLE on maternal and fetal health by trimester, beginning with prepregnancy optimization of maternal health. This is followed by a discussion of NL and the current understanding of the epidemiology and pathophysiology of anti-Ro/La mediated cardiac disease, as well as screening, treatment, and methods for prevention. Finally discussed is the known increase in preeclampsia and fetal growth issues in women with SLE that can lead to iatrogenic preterm delivery.
MeSH term(s)	Female ; Fetal Diseases/epidemiology ; Fetal Diseases/etiology ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases/epidemiology ; Infant, Newborn, Diseases/etiology ; Lupus Erythematosus, Systemic/complications ; Lupus Erythematosus, Systemic/congenital ; Lupus Erythematosus, Systemic/epidemiology ; Lupus Erythematosus, Systemic/etiology ; Pregnancy ; Pregnancy Complications/epidemiology ; Pregnancy Outcome/epidemiology
Language	English
Publishing date	2020-05-10
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	82031-3
ISSN	1097-0223 ; 0197-3851
ISSN (online)	1097-0223
ISSN	0197-3851
DOI	10.1002/pd.5709
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Article ; Online: Changes in plasma soluble urokinase plasminogen activator receptor levels across pregnancy and in relation to hypertensive disorders.

Cowell, Whitney / Limaye, Meghana / Brukbaker, Sara G / Silverstein, Jenna S / Mehta-Lee, Shilpi S / Kahn, Linda G / Malaga-Dieguez, Laura / Reiser, Jochen / Trasande, Leonardo

American journal of obstetrics & gynecology MFM

2023 Volume 5, Issue 5, Page(s) 100825

MeSH term(s)	Female ; Pregnancy ; Humans ; Receptors, Urokinase Plasminogen Activator ; Hypertension, Pregnancy-Induced/diagnosis ; Hypertension, Pregnancy-Induced/epidemiology
Chemical Substances	Receptors, Urokinase Plasminogen Activator
Language	English
Publishing date	2023-02-10
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ISSN	2589-9333
ISSN (online)	2589-9333
DOI	10.1016/j.ajogmf.2022.100825
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Article ; Online: COVID-19 vaccination in pregnancy: early experience from a single institution.

Trostle, Megan E / Limaye, Meghana A / Avtushka, Valeryia / Lighter, Jennifer L / Penfield, Christina A / Roman, Ashley S

American journal of obstetrics & gynecology MFM

2021 Volume 3, Issue 6, Page(s) 100464

Abstract: Objective: Pregnant women are at increased risk for morbidity owing to infection with the COVID-19 virus.: Study design: This was an institutional review board-approved descriptive study of pregnant women at New York University Langone Health who ... ...

Abstract	Objective: Pregnant women are at increased risk for morbidity owing to infection with the COVID-19 virus. Study design: This was an institutional review board-approved descriptive study of pregnant women at New York University Langone Health who received at least 1 dose of an mRNA COVID-19 vaccination approved by the US Food and Drug Administration (FDA) (Pfizer-BioNTech or Moderna) from the time of the FDA Emergency Use Authorization to April 22, 2021. Eligible women were identified via search of the electronic medical record (EMR) system. Vaccine administration was ascertained via immunization records from the New York State Department of Health. Women were excluded if they were vaccinated before conception or during the postpartum period. Charts were reviewed for maternal demographics and pregnancy outcomes. Descriptive analyses were performed using the R software version 4.0.2 (The R Foundation, Boston, MA). Results: We identified 424 pregnant women who received an mRNA vaccination. Of those, 348 (82.1%) received both doses and 76 (17.9%) received only 1 dose. The maternal characteristics and vaccination information are shown in Table 1. Of the included women, 4.9% had a history of a confirmed COVID-19 diagnosis before vaccination. After vaccination, no patient in our cohort was diagnosed with COVID-19. In terms of the pregnancy outcomes, 9 women had spontaneous abortions, 3 terminated their pregnancies, and 327 have ongoing pregnancies. Of the women included, 85 delivered liveborn infants. There were no stillbirths in our population. Of the 9 spontaneous abortions, 8 occurred during the first trimester at a range of 6 to 13 weeks' gestation. There was 1 second trimester loss. The rate of spontaneous abortion among women vaccinated in the first trimester was 6.5%. The 327 women with ongoing pregnancies have been followed for a median of 4.6 weeks (range, 0-17 weeks) following their most recent dose. A total of 113 (34.6%) women, initiated vaccination during the first trimester, 178 (54.4%) initiated vaccination during the second trimester, and 36 (11.0%) during the third trimester. Following the vaccination, 2 fetuses (0.6%) developed intrauterine growth restriction, whereas 5 (1.5%) were diagnosed with anomalies. Outcomes for the 85 women who delivered are shown in Table 2. Of the women who delivered, 18.8% were diagnosed with a hypertensive disorder of pregnancy. The rate of preterm birth was 5.9%. One preterm delivery was medically indicated, whereas the remaining 3 were spontaneous. A total of 15.3% of neonates required admission to the neonatal intensive care unit (NICU). Of the NICU admissions, 61.5% were because of hypoglycemia or an evaluation for sepsis. Other reasons for admission included prematurity, hypothermia, and transient tachypnea of the newborn. Of all the neonates, 12.2% were small for gestational age (SGA) per the World Health Organization standards. Conclusion: This series describes our experience with women who received an mRNA COVID-19 vaccine during pregnancy. In line with other published findings,
MeSH term(s)	COVID-19 ; COVID-19 Testing ; COVID-19 Vaccines ; Female ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome/epidemiology ; Premature Birth ; SARS-CoV-2 ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2021-08-16
Publishing country	United States
Document type	Letter
ISSN	2589-9333
ISSN (online)	2589-9333
DOI	10.1016/j.ajogmf.2021.100464
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Article ; Online: Association of SARS-CoV-2 placental histopathology findings with maternal-fetal comorbidities and severity of COVID-19 hypoxia.

Meyer, Jessica A / Roman, Ashley S / Limaye, Meghana / Grossman, Tracy B / Flaifel, Abdallah / Vaz, Michelle J / Thomas, Kristen M / Penfield, Christina A

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

2021 Volume 35, Issue 25, Page(s) 8412–8418

Abstract: Objective: SARS-CoV-2 is known to impact multiple organ systems, with growing data to suggest the potential for placental infection and resultant pathology. Understanding how maternal COVID-19 disease can affect placental histopathology has been limited ...

Abstract	Objective: SARS-CoV-2 is known to impact multiple organ systems, with growing data to suggest the potential for placental infection and resultant pathology. Understanding how maternal COVID-19 disease can affect placental histopathology has been limited by small study cohorts with mild disease, review by multiple pathologists, and potential confounding by maternal-fetal comorbidities that can also influence placental findings. This study aims to identify pathologic placental findings associated with COVID-19 disease and severity, as well as to distinguish them from changes related to coexisting maternal-fetal comorbidities. Methods: This is an observational study of 61 pregnant women with confirmed SARS-CoV-2 infection who delivered and had a placental histological evaluation at NYU Langone Health between March 19, 2020 and June 30, 2020. Primary outcomes were the prevalence of placental histopathologic features and their association with maternal-fetal comorbidities and severity of COVID-19 related hypoxia. Analysis was performed using Fisher's exact test and Results: Sixty-one placentas were included in the study cohort, 71% from pregnancies complicated by at least one maternal-fetal comorbidity. Twenty-five percent of placentas were small for gestational age and 77% exhibited at least one feature of maternal vascular malperfusion. None of the histopathologic features in the examined placentas were associated with the presence of any specific maternal-fetal comorbidity. Thirteen percent of the cohort required maternal respiratory support for COVID-19 related hypoxia. Villous trophoblast necrosis was associated with maternal supplemental oxygen requirement (67 Conclusion: In pregnancies complicated by COVID-19 disease, there was a high prevalence of placental histopathologic changes identified, particularly features of maternal vascular malperfusion, which could not be attributed solely to the presence of maternal-fetal comorbidities. The significantly increased prevalence of villous trophoblast necrosis in women needing respiratory support suggests a connection to the severity of COVID-19 illness.
MeSH term(s)	Female ; Pregnancy ; Humans ; SARS-CoV-2 ; COVID-19/complications ; Placenta/pathology ; Pregnancy Complications, Infectious/epidemiology ; Pregnancy Complications, Infectious/pathology ; Comorbidity ; Hypoxia/epidemiology ; Necrosis/epidemiology ; Necrosis/pathology
Language	English
Publishing date	2021-09-20
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2077261-0
ISSN	1476-4954 ; 1057-0802 ; 1476-7058
ISSN (online)	1476-4954
ISSN	1057-0802 ; 1476-7058
DOI	10.1080/14767058.2021.1977791
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Article: Factors Associated with Attempted External Cephalic Version for Fetal Malpresentation at Term.

Limaye, Meghana / Abdullahi, Najma / Has, Phinnara / Danilack, Valery A / Froehlich, Rosemary / Werner, Erika

AJP reports

2019 Volume 9, Issue 4, Page(s) e323–e327

Abstract: ... ...

Abstract	Objective
Language	English
Publishing date	2019-10-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2628074-7
ISSN	2157-7005 ; 2157-6998
ISSN (online)	2157-7005
ISSN	2157-6998
DOI	10.1055/s-0039-1695748
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